What is the indication of definitive management for placenta previa?

RRB Nsg Superintendent -29 April 2025 (Shift-1st)

Obstetrics & Gynaecology

Easy

Appeared in: RRB Nsg Superintendent -29 April 2025 (Shift-1st)

Explanation

Definitive management for placenta previa means planned delivery of the fetus and placenta.
This is indicated when the pregnancy reaches term, specifically at or after 37 weeks of gestation.
At this point, the fetus is considered mature, and the risk of severe, life-threatening maternal hemorrhage outweighs the benefits of continuing the pregnancy.
The American College of Obstetricians and Gynecologists (ACOG) recommends delivery for uncomplicated placenta previa between 36 and 37 weeks.

Option A: This describes the goal of expectant (conservative) management, which is employed when the fetus is preterm and both mother and fetus are stable.
Option B: While premature rupture of membranes (PROM) is a serious complication that may lead to delivery, it is not the primary planned indication for definitive management in placenta previa protocols.
Option C: This is an indication for an emergency delivery, not the planned definitive management based on reaching fetal maturity.

Visual 1: Diagram - An illustration showing the different types of placenta previa (complete, partial, marginal, and low-lying) to help visualize the anatomical relationship between the placenta and the cervical os.
Visual 2: Flowchart - A management algorithm for placenta previa, showing the decision points for expectant versus definitive management based on gestational age, bleeding severity, and maternal/fetal status.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain The key concept tested is the indication for definitive (active) management versus expectant (conservative) management in a patient with placenta previa as background academic context rather than a clinical decision trigger.
A critical nursing responsibility is to NEVER perform a digital vaginal examination on a pregnant woman with known or suspected placenta previa, as it can puncture the placenta and cause catastrophic hemorrhage.
Nurses must continuously monitor for signs of bleeding (pad count), maternal vital signs (for hypovolemia), and fetal heart rate (for distress).
Ensuring that at least two large-bore IV lines are in place and that cross-matched blood products are readily available is a key preparedness step for potential hemorrhage.

How to Approach the Question

First, identify the core of the question: it asks for the indication for 'definitive management' of placenta previa.
Understand the key terms. 'Definitive management' in this context means delivery, while 'expectant management' means continuing the pregnancy.
Analyze the options in the context of balancing maternal risk (hemorrhage) and fetal benefit (maturity).
Option A ('Continue pregnancy') is the definition of expectant management, so it is incorrect.
Options B and C ('PROM' and 'fetal asphyxia') are complications that would trigger an emergency delivery, but they are not the planned endpoint of expectant management.
Option D ('at or after 37 weeks') represents the point where the fetus is mature (term), and the risk of hemorrhage to the mother becomes the primary concern, making planned delivery the correct 'definitive' step.

Concept Tested & Keywords

Concept Tested: The key concept tested is the indication for definitive (active) management versus expectant (conservative) management in a patient with placenta previa.
Stem keywords: placenta previa, definitive management, indication
Lead-in keywords: What is

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